Provider First Line Business Practice Location Address:
1800 FORT HARRISON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TERRE HAUTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47804-1413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-839-5500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/16/2006